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CITY OF DIAMOND BAR � • `" Ij � V'�
---��— DEPART[v�NT OF COMMUNiTY 8c DEVELOPMENT SERVICES ������
21825 E.Copley Drive PRESS
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� UCENSED CON7RACTORS DECLAAATION . . —�
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� WORKERS'COMPENSATION LAWS OF CALIFORNIA.AND AGREE THAT IF 1 SHOULD BECAME INSPECTION FEE .
� SU&IECTTO THE WORKERS'COMPENSATION PHOVISIONS OF SECTION 7]OOOF THE IABOR �SSUANCE
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� LENDER'S NAME
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� I CERTIFY THA1 I HAVE REl�THIS APPLICATION ANO STATE THAT THE ABOVE INFORMATION IS CORRECL TOTAL FE ES r� L -W
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